Utilization Management Disclosure

At Community First Health Plans, it is not a condition of employment or part of the evaluation process to base performance ratings, allow compensation or financial incentives for:

The number of adverse determinations

Limitations on lengths of stay, benefits, services, or charges

The number or frequency of telephone calls or other contacts with health care providers or patients

To encourage decisions that result in under-utilization

Utilization Management decision-making is based only on appropriateness of care, service, and existence of coverage.

Members who have questions or who are in need of assistance regarding the Utilization Management process may call Community First Health Plans at:

Local

Toll Free

Medicaid Members:

(210) 358-6060

1-800-434-2347

CHIP Members:

(210) 358-6300

1-800-434-2347

Commercial Members:

(210) 358-6070

1-800-434-2347

ERS Members:

(210) 358-6262

1-877-698-7032

University Family Care Plan Members:

(210) 358-6090

1-800-434-2347

Providers with questions regarding the Utilization Management Process, or who wish to obtain a copy of the criteria used in the decision making process, may call the Health Services Management Resolution Unit at (210) 358-6050.